HIV pre-test informed consent and conveying HIV test results

Who should be offered a HIV test?

You should consider offering a HIV test to any patient who is at risk. Risk factors include:

unprotected sexual contact, particularly contact that took place in a country with a high prevalence of HIV, or with a person who has recently travelled to or migrated from a high prevalence country

travel within a country with a high prevalence of HIV

unprotected male to male sex

presence of a sexually transmitted infection

sharing injecting equipment or the use of unsterile tattooing or body piercing equipment

exposure to unscreened blood or blood products through medical procedures

anyone who is subjected to sexual assault.

Information for patients before the test

Talk to your patient about patient confidentiality and your legal responsibilities, such as the need to notify the Department of Health about any HIV diagnosis. Informed patient consent is always required. You should:

discuss that HIV is a virus that is predominantly transmitted through blood-to-blood contact, or contact with sexual secretions

explain that there is a 3-month window period, and follow up testing may be needed depending on the patient's circumstances

ensure your patient is aware of the possibility of a positive result

explain that positive results are reported to the Department of Health

explain that for positive results there is a requirement for contact tracing, and explain ways this can be done

be aware of cultural understandings of sickness and wellbeing, and whether language is a barrier for understanding

check that the patient knows they have to return to collect the test results in person and organise a follow-up appointment

discuss that, in the event of a positive result, HIV can be treated with ongoing daily medication, and that although HIV is a chronic condition, people who live with HIV can expect to lead long healthy lives and enjoy healthy family life.

Conveying a HIV test result

The process of conveying a HIV test result to your patient, irrespective of the specific result, is affected by the type of test performed, the setting of the consultation and testing and the extent, if any, of additional testing required to confirm the patient’s HIV status.

The person who requests the test is responsible for ensuring that appropriate mechanisms are in place for delivering the test result.

The window period will be determined by the type of test used. More advanced HIV tests can detect infection sooner than others. It is important that a practitioner delivering a test result is aware of what test is being used and how soon after infection it can detect HIV.

A window period of 3 months should be used unless the practitioner delivering a test result is aware of the particular test that was used and its specific window period.

You should ensure the name, result, date of birth and postcode are correct before seeing your patient. Make sure you follow up patients if they don’t attend their appointment.

Conveying a negative result

The decision on how a negative HIV test result is provided – for example in person, by telephone - should be based on clinical judgement by the person responsible for conveying the test.

You should take into account your patient’s level of knowledge, psychological capacity to deal with the outcome of testing and understanding of the testing process, which should be assessed at the time of the sample collection.

Conveying a positive result

A positive result should always be provided in person except in extenuating circumstances. An example of when a result may need to be communicated by phone may arise if the patient does not return for the result, and/or may engage in risk behaviour based on the wrong assumption that they are HIV-negative.

When conveying a positive result, the discussion should include:

giving the test result in person, and in a manner that is sensitive and appropriate to the patient’s gender, culture, behaviour, and language

onwards referral to a HIV specialist, and answering questions about the referral process

specialist assessment at either Royal Perth Hospital or Fiona Stanley Hopsital (see contact details below). Indicate in your referral that your patient has been recently diagnosed with HIV

confirmation that HIV is a condition which can be treated, but not cured

people living with HIV can live long and health lives when on treatment

assessment of any immediate known support (family/friend/partner) who may provide any needed emotional support

onwards referral to a support agency, to be accessed at the patient’s discretion

contact tracing and partner notification

transmission of HIV, and how onwards transmission may be prevented

legal obligations and considerations, for example using condoms and practising safer sex.

Multicultural HIV and Hepatitis Service (MHAHS)

The MHAHS (external site) provides consumer information on HIV and AIDS translated into 25 different languages, along with information for healthcare workers on how to work with people from culturally and linguistically diverse backgrounds.

Testing portal

The ASHM testing portal (external site) is for health professionals ordering, receiving and interpreting the results of HIV, Hepatitis C and Hepatitis B tests. It provides a framework to ensure quality testing is carried out.

WA AIDS Council (WAAC)

The WA AIDS Council provides information and training for health professionals on the different aspects of HIV/AIDS.